Understanding the gap in emergency obstetric and neonatal care in Ghana through the PREventing Maternal And Neonatal Deaths (PREMAND) study

Abstract

Objective To explore basic and comprehensive emergency obstetric service provision across four districts in rural northern Ghana, and whether women were more likely to deliver at facilities with more skilled care. Methods Field workers geo‐coded all health facilities in East Mamprusi, Sissala East, Kassena Nankana Municipal, and Kassena Nankana West districts, and administered surveys to assess providers and emergency obstetric care available. Data were also prospectively collected on delivery locations of women and neonates who died, or nearly died (near misses), between September 1, 2015 and April 30, 2017. Results There were 14 physicians for a population of nearly 360 000 women. Six (6%) facilities could provide basic emergency care, and 3 (3%) could provide comprehensive care. Services were distributed unequally, with 6 (67%) of the emergency facilities located in the least populated district. Among the sample of women and neonates who died or nearly died, 175 (39%) delivered at locations unable to provide basic emergency services. Conclusion Access to emergency obstetric and neonatal care was distributed inequitably across these districts, suggesting the need to revisit geographic placement of facilities relative to population. The study also raised the question of how to ensure facilities are equipped to respond to emergencies.

Bypassing primary healthcare facilities for maternal healthcare in North West Ghana: socio-economic correlates and financial implications

“…By implication, the findings of this study question the practical feasibility of implementing the Ghana healthcare gatekeeper and referral policy. Existing studies have revealed that a lot of PHC facilities in Northern Ghana[ 21 ] and elsewhere [ 19 , 20 ] are less attractive to women seeking maternal care because of lack of midwives, maltreatment of clients, and poor experience of women with the existing healthcare referral system. It is against this background that some scholars have argued that bypassing PHC to higher level facilities may be important for women to obtain quality maternal healthcare[ 18 ].…”

“…Roder-Dewan et al [18] even seem to question the rationale for a gatekeeper system for maternal healthcare in their recent call for redesigning healthcare models in LMICs to shift all child births to higher level facilities such as hospitals. The call attributed global inequities in maternal health outcomes to current healthcare models requiring that substantial deliveries be made at PHC facilities and argues that emerging evidence demonstrates that such PHC facilities lack the capacity to provide quality basic emergency obstetric and newborn care [18][19][20][21]. However, Hanson et al [22] argued that local needs, contextual peculiarities, human resource availability and the need for a strengthened local health system should determine the fitness of recommended healthcare models.…”

Neonatal mortality in rural northern Ghana and the three delays model: are we focusing on the right delays?

“…A study by Kaselitz et al (2019) determined that adequate basic (BEMONC) and comprehensive emergency obstetric and neonatal care (CEMONC) within these study districts are lacking [16]. Only 6% of facilities can provide BEMONC, and only 3% can provide CEMONC.…”

Spatial inequalities in skilled attendance at birth in Ghana: a multilevel analysis integrating health facility databases with household survey data

“…The quality of care provided in the health facilities might have improved, deteriorated or unchanged within this period. Kaselitz and colleagues, for instance, found that a health facility improved in the Upper East region [ 48 ].…”